Abstract
Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13–68), and the median operative time was 26 (range 6–65) min. With a median follow-up of 12 (range 7–25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7–14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.
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References
Stauffer VK, Luedi MM, Kauf P et al (2018) Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 8(1):3058
Berthier C, Bérard E, Meresse T, Grolleau JL, Herlin C, Chaput B (2019) A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: a meta-analysis of randomised studies. Int Wound J 16(5):1119–1135
Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Nouritaromlou MK (2016) Risk factors for complications and recurrence after the Karydakis flap. J Surg Res 204(1):55–60
Gavriilidis P, Bota E (2019) Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis. Can J Surg 62(2):131–138
Tien T, Athem R, Arulampalam T (2018) Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 22(5):325–331
Handmer M (2012) Sticking to the facts: a systematic review of fibrin glue for pilonidal disease. ANZ J Surg 82(4):221–224
Heiskanen V, Hamblin MR (2018) Photobiomodulation: lasers vs. light emitting diodes? Photochem Photobiol Sci 17(8):1003–1017
Wehner M, Betz P, Aden M (2019) Influence of laser wavelength and beam profile on the coagulation depth in a soft tissue phantom model. Lasers Med Sci 34(2):335–341
Parker S (2007) Lasers and soft tissue: ‘loose’ soft tissue surgery. Br Dent J 202(4):185–191
Jain V, Jain A (2012) Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus. J Cutan Aesthet Surg 5(3):190–192
Grubnik VV, Bakhar GA (1993) Primenenie lazera pri khirurgicheskom lechenii épitelial’nogo kopchikovogo khoda [The use of a laser in the surgical treatment of an epithelial coccygeal cyst]. Klin Khir 1:23–25
Klin B, Heller ON, Kaplan I (1990) The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 8(1):31–37
Doll D, Luedi MM (2017) Laser may reduce recurrence rate in pilonidal sinus disease by reducing captured occipital hair. Lasers Med Sci 32(2):481–482
Lindholt-Jensen CS, Lindholt JS, Beyer M, Lindholt JS (2012) Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 27(2):505–508
Brehmer F, Zutt M, Lockmann A, Schön MP, Thoms KM (2013) Nd:YAG laser epilation to prevent recurrences after pilonidal sinus surgery. J Dtsch Dermatol Ges 11(12):1203–1205
Dessily M, Charara F, Ralea S, Allé JL (2017) Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg 117(3):164–168
Georgiou GK (2018) Outpatient laser treatment of primary pilonidal disease: the PiLaT technique. Tech Coloproctol 22(10):773–778
Pappas AF, Christodoulou DK (2018) A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis 20(8):O207–O214
Dessily M, Dziubeck M, Chahidi E, Simonelli V (2019) The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study. Tech Coloproctol 23(12):1133–1140
Harju J, Söderlund F, Yrjönen A, Santos A, Hermunen K (2020) Pilonidal disease treatment by radial laser surgery (FilaC™): the first Finnish experience (published online ahead of print, 2020 Dec 21). Scand J Surg 1457496920975610
Porwal A, Gandhi P, Kulkarni D (2020) Laser pilonidotomy — a new approach in management of complex pilonidal sinus disease: an exploratory study. J Coloproctol 40(01):024–030
Allam H, Anwar H, Essa K (2020) Uses of laser therapy in management of pilonidal sinus. Al-Azhar Int Med J 1(2):26–31
Yardimci VH (2020) Outcomes of two treatments for uncomplicated pilonidal sinus disease: Karydakis flap procedure and sinus tract ablation procedure using a 1,470 nm diode laser combined with pit excision. Lasers Surg Med 52(9):848–854
Khubezov DA, Lukanin RV, Krotkov AR, Ogoreltsev AY, Serebryansky PV, Yudina EA (2020) Laser ablation for pilonidal disease. Koloproktologia 19(2):91–103
Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 372:n71
National Institute for Health and Clinical Excellence (2019) https://www.nice.org.uk/guidance/cg3/documents/appendix-4-qualityof-case-series-form2. Accessed 22 Jan 2021
Karahaliloglu A (2007) First results after laser obliteration of first- and second-degree hemorrhoids. Coloproctology 29:327–336
Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C et al (2009) A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg 27(5):819–823
Naderan M, Shoar S, Nazari M, Elsayed A, Mahmoodzadeh H, Khorgami Z (2017) A randomized controlled trial comparing laser intra-hemorrhoidal coagulation and Milligan-Morgan hemorrhoidectomy. J Investig Surg Off J Acad Surg Res 30(5):325–331
Longchamp G, Liot E, Meyer J et al (2021) Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci 36:485–496
Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54(6):693–698
Maloku H, Gashi Z, Lazovic R, Islami H, Juniku-Shkololli A (2014) Laser hemorrhoidoplasty procedure vs open surgical hemorrhoidectomy: a trial comparing 2 treatments for hemorrhoids of third and fourth degree. Acta Inform Med 22(6):365–367
Faes S, Pratsinis M, Hasler-Gehrer S, Keerl A, Nocito A (2019) Short- and long-term outcomes of laser haemorrhoidoplasty for grade II-III haemorrhoidal disease. Colorectal Dis 21(6):689–696
Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, Del Genio G, Docimo L (2020) Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg 72(3):851–857
Wilhelm A (2011) A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol 15(4):445–449
Giamundo P, Geraci M, Tibaldi L, Valente M (2014) Closure of fistula-in-ano with laser—FiLaCTM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis 16(2):110–115
Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F (2018) Closing perianal fistulas using a laser: long-term results in 103 patients. Dis Colon Rectum 61(5):599–603
Adegbola SO, Sahnan K, Pellino G et al (2017) Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol 21(10):775–782
Kalaiselvan R, Bathla S, Allen W, Liyanage A, Rajaganeshan R (2019) Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis 34(4):561–568
Lund J, Tou S, Doleman B, Williams JP (2017) Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev 1(1):CD011923
Bi S, Sun K, Chen S, Gu J (2020) Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep 10(1):13720
Sharma D, Pratap A, Ghosh A, Shukla VK (2009) Malignant transformation of a pilonidal sinus. Surgery 145(2):243–244
Beal EM, Lee MJ, Hind D, Wysocki AP, Yang F, Brown SR (2019) A systematic review of classification systems for pilonidal sinus. Tech Coloproctol 23(5):435–443
Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Meysamie A, Nouritaromlou MK (2015) Karydakis flap versus excision-only technique in pilonidal disease. J Surg Res 198(1):260–266
Saber A (2014) Modified off-midline closure of pilonidal sinus disease. N Am J Med Sci 6(5):210–214
Brusciano L, Del Genio G, Tolone S, Schiano di Visconte M, Gualtieri G, Terracciano G, Gambardella C, Docimo L (2019) D-shape asymmetric excision in recurrent pilonidalis disease: an analytic longitudinal long-term evaluation. Updates Surg 71(4):723–727
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I.R. designed the study. G.A. and T.B. participated in data extraction, analysis, and writing of the manuscript. B.B. and T.M critically revised the manuscript and statistical results. All authors approved the manuscript and this submission.
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Romic, I., Augustin, G., Bogdanic, B. et al. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci 37, 723–732 (2022). https://doi.org/10.1007/s10103-021-03379-x
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DOI: https://doi.org/10.1007/s10103-021-03379-x